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Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients
BACKGROUND/AIMS: The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Association for the Study of the Liver
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9845679/ https://www.ncbi.nlm.nih.gov/pubmed/36064306 http://dx.doi.org/10.3350/cmh.2022.0181 |
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author | Wong, Yu Jun Zhaojin, Chen Tosetti, Guilia Degasperi, Elisabetta Sharma, Sanchit Agarwal, Samagra Chuan, Liu Huak, Chan Yiong Jia, Li Xiaolong, Qi Saraya, Anoop Primignani, Massimo |
author_facet | Wong, Yu Jun Zhaojin, Chen Tosetti, Guilia Degasperi, Elisabetta Sharma, Sanchit Agarwal, Samagra Chuan, Liu Huak, Chan Yiong Jia, Li Xiaolong, Qi Saraya, Anoop Primignani, Massimo |
author_sort | Wong, Yu Jun |
collection | PubMed |
description | BACKGROUND/AIMS: The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients. METHODS: cACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis. RESULTS: One thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB. CONCLUSIONS: Non-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients. |
format | Online Article Text |
id | pubmed-9845679 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The Korean Association for the Study of the Liver |
record_format | MEDLINE/PubMed |
spelling | pubmed-98456792023-01-31 Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients Wong, Yu Jun Zhaojin, Chen Tosetti, Guilia Degasperi, Elisabetta Sharma, Sanchit Agarwal, Samagra Chuan, Liu Huak, Chan Yiong Jia, Li Xiaolong, Qi Saraya, Anoop Primignani, Massimo Clin Mol Hepatol Original Article BACKGROUND/AIMS: The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients. METHODS: cACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis. RESULTS: One thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB. CONCLUSIONS: Non-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients. The Korean Association for the Study of the Liver 2023-01 2022-09-05 /pmc/articles/PMC9845679/ /pubmed/36064306 http://dx.doi.org/10.3350/cmh.2022.0181 Text en Copyright © 2023 by The Korean Association for the Study of the Liver https://creativecommons.org/licenses/by-nc/3.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Wong, Yu Jun Zhaojin, Chen Tosetti, Guilia Degasperi, Elisabetta Sharma, Sanchit Agarwal, Samagra Chuan, Liu Huak, Chan Yiong Jia, Li Xiaolong, Qi Saraya, Anoop Primignani, Massimo Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
title | Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
title_full | Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
title_fullStr | Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
title_full_unstemmed | Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
title_short | Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
title_sort | baveno-vii criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9845679/ https://www.ncbi.nlm.nih.gov/pubmed/36064306 http://dx.doi.org/10.3350/cmh.2022.0181 |
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